Breast Cancer in Today's World
fortunately treatment is getting better and less invasive
Back in the 14th century, breast cancer was known as the nuns’ disease. At that time it appeared that the disease afflicted mainly nuns. Today however all women are at risk of breast cancer. In 2007, TIME magazine reported that 1 million women in the world will be diagnosed with breast cancer that year. In the United States of America, 1 in 8 women will develop breast cancer in their lifetime. In Asia, the incidence is less but rapidly rising to match Western numbers.
It has been postulated that changes in our lifestyles over the decades are partly responsible for this increase. Women are delaying childbearing and having fewer or no children. Girls begin menstruating earlier and women enter menopause at a later age. Use of hormone replacement therapy after menopause, a Westernized diet high in red meat and fat content, prevalence of obesity and lack of regular exercise have also been blamed.
The American Cancer Society encourages women to have a healthy diet of fresh fruits and vegetables, reduction in consumption of red meat and fats, prevention of obesity/weight gain, and regular exercise at least 5 times a week to reduce cancer risk. However, many other factors such as hormonal and genetic effects cannot be changed. The best strategy hence is early detection and treatment of breast cancer.
Mammogram screening is the gold standard for detecting early cancer change in the breasts. All women above the age of 40 should undergo regular mammogram screening. There is anecdotal evidence that women with dense breasts or who have a family history of breast cancer should also consider adding ultrasound (but not replacing mammography) for screening. In addition, all women should perform monthly breast self examination to detect any abnormal changes in their breasts such as lumps, rashes or nipple discharge.
Detection of an abnormality is usually followed by a biopsy to confirm the diagnosis. Almost always a simple needle biopsy under local anaesthesia in an outpatient setting can be done, without having to undergo surgery for diagnosis.
When breast cancer is diagnosed, treatment is multi-disciplinary in nature. Surgery is always required whereas chemotherapy and radiotherapy may also be needed depending on type of surgery and stage of disease. Oral medication may also be prescribed for hormone receptor positive cancer.
Surgery for breast cancer is no longer as debilitating as once thought. Long gone are the days when a diagnosis of breast cancer equated to loss of the breast. In a large majority of early breast cancer cases, the breast can be conserved by removing just the tumour with a rim of normal tissue. Oncoplastic surgery techniques are then employed to obliterate the tissue defect so that the final cosmetic appearance of the breast approaches as near normal as possible.  Alternatively, sometimes chemotherapy can be given first to shrink the cancer in order to allow a smaller volume of breast tissue to be removed. For women who require removal of the whole breast, they may choose to have immediate breast reconstruction using either their own fatty/muscle tissue, a silicone implant or a combination of both. The cosmetic results are very good and it is a tremendous boost to a woman’s body image after breast cancer treatment.
Part of breast cancer surgery involves removal of the lymph nodes under the armpit for accurate staging. As recent as ten years ago, the standard practice was to routinely remove all the lymph nodes. This may result in shoulder stiffness, weakness and arm swelling for some women. In the past years, a new technique termed sentinel lymph node biopsy reduces the need for such radical surgery. The surgeon uses a radioactive tracer, a blue dye or both to identify and remove the first draining lymph node(s) in the armpit. These sentinel lymph nodes are then tested for cancer. If the cancer is early and the nodes are negative for cancer, the remaining lymph nodes do not need to be removed and the woman avoids the complications associated with radical surgery. The surgeon will remove all the lymph nodes only if the sentinel lymph node contains cancer.
Breast cancer should not be feared. Almost every woman will know a friend, colleague or relative who has been treated for breast cancer. The good news is that the cure rates for breast cancer are very high if it is diagnosed and treated appropriately in the early stages. Treatment has also become more sophisticated with many options and fewer long term undesirable sequelae if the cancer is detected early. Lead a healthy lifestyle with a good diet and exercise, go for screening and seek medical advice when there is an abnormality. We can surely win this battle.
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